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Home My WebLink About19510-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19723 DATE: February 12, 1991 THIS CERTIFIES %hat the building ALTERATION Location of Property 1000 PRIVATE ROAD #4 (MUNN lANE) House No. Street County Tax Map No. 1000 Section 17 Block 2 Subdivision Filed Map No. ORIENT¢ N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 1990 pursuant to which Building Permit No. 19510-Z dated NOVEMBER 9, 1990 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is REBUILD EXISTING DECK AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A LAWRENCE B. DORMAN Rev. 1/81 · OR,B[ HO. fl · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PEIIM. IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 1 951 0 Z c~to ...... ~..~Lu~ c/ , ~,~.~...o Permission is hereby granted to: _/ -. _11.,~ ,."~- .,__ ..... ~....~ ........... :.~ ............ ~..: ................. ..... .-~..~.~ ............. ~.~ .............. ,,..~ ~ ...... . ,o ................. i ..... County Tax Ma~'--~i'~0 Sect,on' .... .~.1..~ .......... Block ...... .~l ............ ~- Lot No .... J. ...... ~ ........... pursuant to application dated .... ~..~.~ ........................ j , 19.~.., and approved by the Building Inspector. Building Insi~ector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEP~TMENT TOWN HALL 765-1802 6LDG, DEPT,, TOWN OF $OUTHOLD _ APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. I If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ~. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additiohs to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..... / .... ~ ............................... ~:ew Construction ........... Old Or Pre-existing Building... Y .. . Location of Pro crt /~ P Y ..................... ~. House No. Street Hamlet D~wer or Owners of Property County Tax Map No 1000, Section....~.....Block.,.......~.......Lot...~.~.. .......... . ... Subdivision ................................... · Filed Map ........... . Lot ...................... Permit No. ~.5--/~ ~ .Date Of Permit.. ~/~~. A 1' ~~ ~ ~l~ ........... · pp zcant ............................. Health Dept. Approval ......................... . Underwriters Approval .... ~ ..................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ..... ' '"' ......... FIELD · ~O~_2~DLTZ O__.W --.., {~st) FO~UNDATION ( 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL IIDATE COMM£NT£ ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~.~ .Ch 19 .~..b Approved ? ~ ~.t~., 19 $0. Permit No. ~. ~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... survEY CHECK ...... SEPTIC FORM ............. NOTIFY CALL MAIL ;0' :'(,~ i - I 1990 BLDG, TOWN OF INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~hall be kept on the premises available for inspection throughout the work. ~. e. No building shall be oqcupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to. admit authorized inspectors on premises and in building for necessary inspectio~_~qx_j~ / ~/~/~ · ..................... /.<../....~9~..~. ·v. .y~..t. ........ (Signature of applicant, or name, if a corporation) .f.: .................... (Mailing address of applicant) State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ E ....................................................... Name of owner of premises . ./~?,. ~' '~' ~'~' 'X''. ,~..~. X .1.~..~. 73 ............. ' .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ...... /~)..~.~ .O... itlt.~..... Plumber's License No. ~ Electrician's License No ....................... F~ ~I..~[ Other Trade's License No..~ ........... I) -~ ~C~ ..... xr'' ' /' 1. Location of land on which proposed work will be done ..... Z.~/. ?..t4. M...&..~.. ?..~....~.~. ?../?.~..~: {} ......./.~,.~ House Number County Tax Map No. 1000 Section .... I. '.~ ........... Block ....... ~ ........ Lot... [..~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... D..t~. .~. -//l~ ............ ...................................... b. Intended use and occupancy .../~). · .tSJ..~.././l.~.}. 3. Nature ofwo~heck which applicable): New Building ..... ' ..... Addition... ! ...... Alteration .......... Repair .............. Removal .............. Demolition .......... i Other Work ............... fl .~. ~.O.{:9 ~,~""~' ~ ! (Description) 4. Estimated Cost ............. , ................... Fee . .,.*%.~. :..~ .......................... ' (to be p~id on filing this application) 5. If dwelling, number of dwelling units ...... / ........ Number of dwelling units pn each floor ................ If garage, number of c~s ...~ ........................................ ~ .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe~of use ............ ~ ..... 7. Dimensions of ~ting structures, if any Front... ~ f ...... Rear ~.t ....... Depth ... ~ ~ ... Height Z ~.~ .... NumberofSto~es...~.~..~..~ ..... ~ ..................... ~.~...~'~ D~ensions of same structure ~with alterations or additions: Front ...~.~ R. ..... Rear ...~.~. ~ ...... Depth ...... ~ ~ ........ HeiSt .. ~ .~ ........... Number of 8. Dimensions of entire new construction: Front ....... ~:.'. .... Rear ......... '~ ..... Depth .. ~: .......... Height ~ Number of Stories ~ 9. Size of lot: Front ..... ~'; .............. Rear .... ~ . .......... D~pth ...~: ................. 0. Date of Purchase .~' . . ..................... Name of~er Omner ~., .......................... 1. Zone or use district in which premises are situated ..... ~.~.~.~ u.~.t.~/.. I .......................... 2. Does proposed constructiq~violate any zoning law, ordinance or regulation: .. ~ ......................... 3. Will lot be regraded ... ~.~.~.., ....... ~ ......... Will excess fill be removed from premises: Yes No 4. N~e of Owner of premises ~ffg. ~y. ~V~f~.~ Address ~ ~i ~.~. ~Phone No. ~/~7~.~. N~e of Architect ...~ ~..~., .................. AddressZ~'...y ~ ~. ~q~, Phone No. ~ .............. N~e of Contractor .~ ~.b~q~.~ ~ ~e. Address ~ET~"~ ~ ~.~.~ Phone No ~.27~.~. .5. Is this property located within 300 ~eet of a tidal w~ian~V'*Yes~22... No '~ .... *If yes, Southold To~ Trustees Permit maybe reouired. PLOT DIAG~M Locate cle~ly ~d distinctly ~1 bufld~gs, whether existing or proposed, and. indigate ~1 set-back d~ensions from ~rope~y Hnes. Give street and block number or desc~ption accord~g to deed, ~d show street nines and indicate whether nte~or or corner lot. ~ ./~ ~Z ' ' L FOLLOWING 1[,4~ Pf¢ ~ ~[~ '* ;. 1. FOUNDATION r '.,,4t,i FOR POURED CONCRETE 2. RouGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRLICTION MUST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF TilE N,Y, STATE CONSTRUCTION 81 ENERGY ~ ,~C.O,D ~,. ~;~.O'~l'..~Fm~po N S I B LE FOR .....,~" · · · ;-:,',-~5' ',' ~ ' - ~...C...~....~....~.~'' ..................... being duly (Name of individual signing contract) named. sworn, ~ · · "M,,. '~:~,~ .~ .... ie is the ................................................ ' ........................ (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application ar~ ~rue tO the best of his kpowledge and belief; and that the /ork will be performed in the manner set forth in the applicatiofi filed therewith !, worn to before me this R0~ERT ................. ' ~TI~BI.iP~...~l_.~ (Signature of applicant)